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Informed consent is obtained. All patients undergo pre-operative bowel preparation and receive prophylactic antibiotics. After placement in lithotomy position with arms tucked in the sides, a Foley catheter is inserted. A uterine manipulator is positioned.

The patient is placed in steep Trendelenburg position. Based on surgeon preference of endoscope size, a 5, 10, or 12mm bladeless trocar can be found in the umbilicus under direct visualization of the abdominal cavity. If the patient has a prior mid-line incision, entry can be made at Palmer’s point 2cm below the left costal margin in the mid-clavicular line.

The abdomen is insufflated, and three more bladeless trocars (5, 10, or 12mm) are placed in the right lower quadrant, left lower quadrant, and also the mid-line 2cm above the pubic symphysis. A minumum of one from the three trocars must measure 10 or 12mm to be able to permit lymphadenectomy. An abdominal survey will be performed to eliminate intraperitoneal disease. The bowel is mobilized out of the surgical field.